Asthma Bronchial Asthma

Western medical treatment of their asthma drugs with asthma are often used as asthma medication, the clinical significance of the most important aspects on the basis of their meaning in turn divided into:
(A) of the bronchodilator drug, the main role of this drug except for the relaxation of the bronchi, the control of acute symptoms of asthma.
1st β2-agonists: β2-agonist drugs dozens of varieties, can be divided into three generations. ① First Generation: non-selective β2-agonists such as adrenaline, ephedrine and isoproterenol, etc., because of its cardiovascular side effects, it is highly selective β2-agonist is replaced. ② The second generation: the short-acting β2 selective agonists such as salbutamol (salbutamol), terbutaline (terbutaline) and phenolic C Chuanning (fenoterol) and so on, reaction time 4 to 6 hours, the side effects on the cardiovascular system significantly reduced. ③ the third generation: a new generation of selective long-acting β2-agonists, such as (salmeterol), Fumiteluo (formoterol) and procaterol (procaterol) and so on. Action time> 12 hours, particularly for nocturnal asthma. But some drugs (eg, salmeterol) slow onset time. In general, to β2-agonists ease symptoms of acute first-line drugs, the most commonly used second-line treatments. The third generation of drugs used in combination with inhaled corticosteroids to stabilize the airway and to reduce the attack role.
β2-agonists, inhaled, under the oral or intravenous, inhalation of the election can be conducted, the role of fast, high dose of respiratory tract, systemic side effects. The methods of quantitative aerosol inhaler (MDI), dry-powder inhaler and prolonged inhalation. To MDI is the most common.However, MDI use, breathe synchronously syringes, medical staff need advice and regular review of methods used thoroughly to ensure their effectiveness. In children, elderly or seriously ill patients, the storage in the bottle MDI add fog (spacer), exhaled aerosols drug remains in the bottle, the patient could easily inhaled and can drop deposition in the oropharynx to reduce by stimulation.
2nd Theophylline daily oral dose of aminophylline Rule 5 ~ 8 mg / kg, slow release theophylline daily 8 ~ 12mg/kg. The intravenous administration in critically ill patients with asthma in particular used. The first dose of 4 ~ 6mg/kg but also for the slow injection, the injection should more than 15min, the amount ofŁ.0mg/kg per hour by intravenous infusion to 0.8 ~, takes a daily dose of no more than maintain ~ 750mg 뽨mg.
Theophylline side effects in the gastrointestinal tract (nausea, vomiting), cardiovascular symptoms (tachycardia, arrhythmia, hypotension), respiratory center even the excitable can, in severe convulsions and death. The best in the surveillance of plasma concentration of the drug, aminophylline, safety concentration of 10 ~ 20μg/ml. Fever, pregnancy, children and the elderly, people with liver, heart, kidney dysfunction and hyperthyroidism, in particular, must be used with caution. Combined cimetidine, quinolones, macrolides and other drugs can slow the elimination of theophylline metabolism should reduce the dosage.
grd Inhaled anticholinergics anticholinergics such as ipratropium bromide (Ipratropine bromide), etc., can block the postganglionic vagal nerve, thereby blocking the sky vagus excitability bronchial relaxation effect and reflex bronchoconstriction. strengthen Β2 agonist therapy with inhaled bronchodilators and combined effect permanently, β2-agonists alone are not particularly used to the symptoms of asthma patients, on the merger with chronic obstructive pulmonary disease control, particularly suitable. Available MDI or continuous inhalation, 3 to 4 times daily, each 75 ~ 250μg inhalation. The occurrence of about 15 minutes for 6 to 8 hours. Few side effects, a small number of patients have pain or dry mouth mouth feel.
(B) the control of the disease as anti-inflammatory drugs or drugs known. Since the pathological basis of asthma, chronic nonspecific inflammation, so that control of chronic airway inflammation is the basic treatment of asthma, playing the ideal long-term control of asthma an important role. Commonly used drugs are corticosteroids and inhaled drugs color ketones.Several new drugs such as leukotriene receptor antagonists, long acting β2-agonists and controlled release theophylline has certain anti-inflammatory effect.
1st Glucocorticoids glucocorticoids (the hormone) is currently the most effective drug against the disease. The primary mechanism is the inhibition of migration, and activation of inflammatory cells, inhibit cell factor production, inhibiting the release of inflammatory mediators, improve, β2-receptor in smooth muscle reactivity. Can be divided into inhalation, oral and intravenous drug use.
Inhaled corticosteroids to control asthma long-term stability of basic treatment is the first line of asthma treatment. Inhaled corticosteroids by increasing the molecular structure of the ester groups, so that the local anti-inflammatory potency quickly by a sharp increase in the role of the respiratory tract, the use of a lower dose of medication into the bloodstream after it inactivated in the liver, less systemic side effects. The main side effects are oropharyngeal discomfort, pharyngitis, hoarseness, oropharyngeal candidiasis or infection, gargle with water after spraying may reduce local reaction. Inhalation or the use of different drugs, the incidence of pharyngitis and is something else. can disable oropharyngitis usually 4-7 days, the natural recovery. There are two commonly used steroid betamethasone propionate training chloride (beclomethasone dipropionate), budesonide (budesonide) inhaled flunisolide (flunisolide) and triamcinolone (triamcinolone acetonide), etc.. In recent years, more new inhaled corticosteroid activity, such as fluticasone propionate (fluticasone) and develop so on. 2-fold increase in its role, few side effects. With MDI, dry powder or continuous inhalation. Slow starts need long-term regular inhaled to an effective, continuous application of the best role for over a week must be longer than 3 months away. Dose inhaled asthma conditions in the overall 200 ~ 1200μg / d.
Oral or intravenous hormone is moderate to severe asthma attack, an important therapeutic drugs. select, in accordance with the condition, appropriate dosage and treatment regimen (see Table 1), symptoms gradually decrease and the disabled, sequential use of inhaled steroid.
2nd Disodium anthocyanin is a non-steroidal anti-inflammatory drugs. Mechanisms are still not well understood, stabilize the mast cell membrane, inhibiting the release medium, release of other inflammatory cells into the medium also a certain degree. Current clinical application of less.
3rd Desensitization therapy: also known as an allergen vaccine therapy, is an important treatment of asthma, rhinitis and its effectiveness in patients with asthma confirmed. The most important clinical target dust mites and pollen to a variety of desensitization therapy. Study confirms that the treatment can change the natural course of asthma in a few years after cessation of treatment efficacy. In recent years, many researchers advocate sublingual desensitization therapy as a sublingual desensitization treatments to avoid repeated injections of hardship and suffering, therefore, particularly suitable for children. However, further research is necessary to compare the sublingual desensitization desensitization treatment, treatment and injection have the same effect. Details can be found in the extended reading 1 And 2 are found.
4th Anti-IgE monoclonal antibody: a new order for the human IgE monoclonal antibody (brand name Xoalir), has in the treatment of allergic rhinitis and asthma, a significant influence. May 2003, the FDA approval to market formally. Xoalir in the treatment of moderate – severe asthma and seasonal and perennial allergic rhinitis are effective, known Xoalir serum IgE levels are reduced, low-regulation in basophils in the peripheral blood of the IgE receptor, significantly reduced nasal and bronchial eosinophils, mast cells and T-cells and B-cell numbers. Research shows that inhalation of high doses of hormones that are outside the control of asthma, Xoalir significant benefits have remained. Clinical data suggest that persistent allergic rhinitis with Xoalir can improve breathing with asthma symptoms, improve quality of life and management of acute, often on Xoalir good effect in patients with severe asthma. Xoalir anti-inflammatory treatment with the inhibition of IgE are associated. Xolair clinical dose is 125 mg ~ 375 mg subcutaneously once every 2 to 4 weeks. The drug can also improve the CARAS the upper respiratory tract and lower respiratory symptoms.
5th White 3 thin regulators, including the leukotriene receptor antagonists and synthesis inhibitors (5 – lipoxygenase inhibitor). Now successful in clinical cysteinyl leukotriene receptor antagonist used Zhalusite (Zafirlukast 20mg twice daily) and Montelukast (Montelukast10 mg once daily) to relieve not only asthma symptoms, and can reduce inflammation of the airways, has some clinical effect in patients, do not use hormones or a combination can be used. The main side effects are gastrointestinal symptoms, usually easy, a small number of skin rash, angioedema, elevated aminotransferase levels returned to normal after treatment.
6th Antihistamines should: Due to allergic rhinitis – allergic asthma syndrome for the disease once diagnosed as early as possible be given antihistamines. Effective control of asthma, allergic rhinitis, the most asthma-attack to avoid or prevent an increase, the use of antihistamine treatment of allergic rhinitis on the improvement of the prognosis of asthma. doses of antihistamines to prevent the common effective treatment of allergic rhinitis to asthma attacks, double the dose of concurrent asthma symptoms can be improved. Pseudoephedrine plus antihistamine treatment for allergic rhinitis – asthma syndrome in improving nasal symptoms but also improvement of asthma symptoms, improvement of PEF and reducing the amount of bronchodilators. may worsen in children, infections of the upper respiratory tract and asthma can be controlled by continuous antihistamine treatment. In the early treatment of children allergic constitution (early treatment of atopic Child ETAC) study found that continuous treatment antihistamines can reduce the incidence of asthma.